Egyptian Program May Be Roadmap for Treating Large Populations of HCV Patients

A public health experiment in which the Egyptian government has obtained large quantities of sofosbuvir for much less than its retail price is impacting the lives of tens of thousands of people.

A feature in the New York Times told the story of an Egyptian effort to cure hepatitis C virus infection in a way that may be applicable to other parts of the world.

The effort is notable both because of the high prevalence of HCV in Egypt and because of that nation’s poverty. Millions of Egyptians contracted HCV during a period in which many shared un-sterile needles while being inoculated against schistosomiasis, a parasitic disease spread by water snails. Today, according to the article, nearly 10% of the Egyptian population is infected with HCV, and more than 150,000 new cases are diagnosed each year.

Now, however, a public health experiment in which the government has obtained large quantities of Gilead’s blockbuster treatment, Sovaldi (sofosbuvir) for much less than its retail price is impacting the lives of tens of thousands of people -- soon to be hundreds of thousands. In the first year alone, a total of 125,000 patients have been treated with sofosbuvir, and many more will be treated in 2016 and beyond. The follow-up drug, Harvoni, is being tested for a swift roll-out. And competition from AbbVie, Bristol Meyers-Squibb, and others is on the way, too.

The controversy stems not from the treatment program in place in Egypt, but the tight controls in place to protect lucrative markets for the drug and its emerging competitors in the United States and other areas, including a stipulation that patients open bottles of the medication and take one on the spot when filling a prescription at pharmacies. These and other restrictions have ruffled the feathers of patient advocates, who bemoan the intrusion of a pharmaceutical company into the doctor-patient relationship, among other issues.

Also in question is potential trouble in the form of generics becoming available that could lead to a different overall environment in Egypt’s private pharmacies, where the restrictions won’t be easily enforced.

While few would question the rights of a pharmaceutical company to pursue a profit, questions about the ethics of maintaining high prices for the drugs in certain markets while making them more widely and cheaply available in other markets may also lead companies like Gilead to reconsider what might otherwise be considered a public good. Certainly, millions of Egyptian patients will ultimately benefit, but time will tell if such programs are sustainable and more widely applicable.

For a more in-depth look at this issue, read Gale Scott's “Hep C Drugs: Prices to Plummet, but Not in the US.”